title: Factors affecting employment at initiation of dialysis.
abstract: OBJECTIVE
  Half the individuals who reach ESRD are working age (< 65 years old) and many are at risk for job loss. Factors that contribute to job retention among working-age patients with chronic kidney disease before ESRD are unknown. The purpose of the study is to understand factors associated with maintaining employment among working-age patients with advanced kidney failure.
  
  
  METHODS
  In this retrospective study we reviewed the United States Renal Data System database (1992 through 2003) and selected all patients (n = 102,104) who were working age and employed 6 months before dialysis initiation. Factors that were examined for an association with maintaining employment status included demographics, comorbid conditions, ESRD cause, insurance, predialysis erythropoietin use, and dialysis modality.
  
  
  RESULTS
  Maintaining employment at the same level during the final 6 months before dialysis was more likely among (1) white men ages 30 to 49 years; (2) patients with either glomerulonephritis, cystic, or urologic causes of renal failure; (3) patients choosing peritoneal dialysis for their first treatment; (4) those with employer group or other health plans; and (5) erythropoietin usage before ESRD. Maintaining employment status was less likely among patients with congestive heart failure, cardiovascular disease, cancer, and other chronic illnesses.
  
  
  CONCLUSIONS
  The rate of unemployment in working-age patients with chronic kidney disease and ESRD is high compared with that of the general population. Treating anemia with erythropoietin before kidney failure and educating patients about work-friendly home dialysis options might improve job retention.
authors.affiliation: Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Section of Nephrology, Madison, Wisconsin, USA. rmh@medicine.wisc.edu
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Muehrer
authors.forename: Dori
authors.initials: D
authors.lastname: Schatell
authors.forename: Beth
authors.initials: B
authors.lastname: Witten
authors.forename: Ronald
authors.initials: R
authors.lastname: Gangnon
authors.forename: Bryan N
authors.initials: BN
authors.lastname: Becker
authors.forename: R Michael
authors.initials: RM
authors.lastname: Hofmann
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D019992:Databases as Topic; D004651:Employment; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D014478:Unemployment; D014481:United States; D055815:Young Adult
chemical_list: D006397:Hematinics; D004921:Erythropoietin